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I arrived in Little Rock, Arkansas on Sunday the 19th of March, a little unsure of myself in a part of the country that I haven’t explored very much. I felt welcome from the first night on, though, after a warm dinner with fellow intern Chris Diehl and our Princeternship host, Dr. Erika Petersen ‘96(’96). We learned about the operations that Dr. Petersen had scheduled throughout the week and got a taste of her favorite pizza place in Arkansas. Once we had the week outlined, we started talking about some of our common experiences at Princeton and what we could look forward to in medical school.

We started the first day early for me at 6:45 am, but I soon became aware that this was a bit late for by hospital standards. Chris and I put on scrubs and met with Dr. Petersen’s patients for the day. Pretty soon I was observing my first surgery, and Dr. Petersen was careful to explain what she did and gave us a firsthand view of the procedure. I was thoroughly impressed with the expert knowledge of the body that Dr. Petersen displayed in replacing an electronic device that had been implanted in a patient. After finishing with the first patient she immediately got to work on a more complicated case which made full use of the cutting edge technology of deep brain stimulation. The patient whose surgery we observed had a noticeable alleviation of symptoms for a disease that I did not know could be treated so effectively, and I was really impressed to see it. We finished off the day by observing a spinal surgery that made use of another advanced technology to stay minimally invasive while making a dramatic intervention in the structure of the spine.

On the next day at the hospital, we got a broader survey of what surgeons at UAMS do. We started a bit later than the day before and split up between different surgical teams. Between me, Chris, and Arthur, another student observing surgeries for the week, we saw urological surgery, cardiothoracic surgery, and more neurosurgery. This packed day wrapped up with Dr. Petersen performing a spine surgery on an awake patient while explaining each step to Chris and me. We said goodbye to Dr. Petersen but hung around the surgery wing to observe an open heart surgery. Watching the heart beat inside a patient while the surgeons went to work was a really inspiring experience, especially having studied the heart so much without ever seeing one in action. Later on Dr. Petersen took Chris and me to dinner at a really impressive sushi restaurant, and we had a good chance to debrief a lot of our experiences and get a little more personal insight on the life story of a doctor.

On the Wednesday morning of our Princeternship Chris and I managed to wake up early enough to follow the residents for morning rounds. I’ve heard a lot about the intense lives of residents, so I was eager to see what things were like first hand. After finding our guide, a particularly helpful resident named Dr. Gandhi, we started visiting patients and listening to their symptoms and statuses. The residents on rounds displayed an impressive ability to take in and put together a stream of information about patients that needed diagnosis or treatment. Refreshingly, they all also seemed to enjoy their daily routine a lot, despite the intensity of life as a neurosurgery resident.

David, Dr. Petersen, and Chris

Following this, Chris and I observed the removal of a brain tumor by Dr. Day, the chair of neurosurgery at UAMS. We watched him perform the procedure while following the steps in a book describing the procedure that a resident had provided. Toward the end of the surgery we were surprised to learn that the author of this textbook was none other than Dr. Day himself! This was a really artful surgery, with a lot to appreciate how much the patient’s life would improve directly as a result. We ended the day with a visit to Dr. Petersen’s clinic, which really put more of a human face on the practices we had observed. Dr. Petersen seemed to really do her best to explain the technical side of complex procedures to patients, who in turn really appreciated the transparency and compassion she showed.

The last day of my Princeternship was in some ways the most exciting. I was lucky enough to see Dr. Petersen herself remove a very serious tumor from a patient in a very involved procedure which I was able to observe start to finish. Also, Dr. Petersen sent a sample of the tumor down to the hospital’s pathology unit, and I got a chance to see this other part of the hospital as well. The pathologist there classified it and explained what to look for and the severity of different types of brain tumor. Luckily for me, Dr. Petersen finished this very thorough tumor removal in time to grab a final bite to eat with me before I made my way to the airport to fly home.

We ate with Arthur and Dr. Gandhi and had a conversation that was enlightening for me about the role of research in medicine. Dr. Gandhi, an MD/PhD who worked on metabolism of neural cells during his PhD, had a lot of insight to share with me since I’m interested in pursuing an MD/PhD and I’m involved in metabolism research. Dr. Petersen also shared a few thought provoking stories about the history and future of neurosurgery research. I left that night with nothing but positive experiences from my Princeternship, for which I really have to thank Dr. Petersen for carefully setting up such an inspiring experience for undergrads. I would highly recommend this Princeternship to future students as an opportunity to get a first hand view of the practice of medicine and the positive things it can bring about.

My host, Dr. John Gordon ’85 picked me up in DC at 7:15 in the morning to drive over to Dominion Fertility Clinic in Arlington, VA. He introduced me to the nurses and Dr. DiMattina, who founded the clinic. Early in the morning, I watched Dr. G perform vaginal ultrasounds for several patients. It was really interesting to see how they were at different stages of various treatments: for some patients, Dr. G was looking at the thickening uterus lining and how the ovaries were doing, and for one patient, we could already see 20 follicles in the ovaries from stimulated growth, ready to be collected for IVF. The most fascinating one was being able to see the embryo inside the uterus of one of the patients and hear its heartbeat.

Around 10:00, some patients came in for consultation, which I got to watch Dr. G do in his office. It was insightful for me to learn how Dr. G interacted with the patients. He was frank and reassuring when giving them advice, explaining all the different options that were suitable for each couple’s situation, like stimulated vs. natural IVF, frozen embryo transfer vs. using fresh embryos, and the different tests for a couple who wanted to know where they stood in terms of fertility. It was almost overwhelming that there were so many different factors to consider when a couple was deciding on the right procedure for them, like what would be best emotionally, financially, health-wise, etc. I was surprised to learn that the couples who come to the clinic are from different parts of the country, not necessarily all from Virginia, because Dominion Fertility is the only clinic where the percentage of IVFs performed are as high as 70% natural cycle IVF as opposed to stimulated cycle. Since natural cycle produces only one egg and hence one embryo, it makes the successful pregnancy rates seem lower for a clinic, and that’s why not many of them are willing to offer the natural. One final procedure that Dr. G performed before lunch was assisting in the collection of an egg. While Dr. G was with the patient, I went into the lab with Dr. Ning and saw the actual collected egg under the microscope, which was amazing. Dr. Ning cleaned the surrounding of the egg and stored it at the optimum temperature and concentration of CO2.

After a quick lunch out, I had some cool conversations with Dr. G about life at Princeton and about how he decided on reproductive endocrinology after having really enjoyed it during his residency.

When we got back, I followed Dr. Ning again and saw the same egg, this time being fertilized by intracytoplasmic sperm injection (ICSI) and inserted back into the uterus of the patient.

I really felt what Dr. G meant when he said that there was a sense of gratification and accomplishment, as I went through in my head all the patients that we had seen today: from couples seeking the right treatment to those going through the procedures, to the patient who confirmed her pregnancy and heard her baby’s heartbeat, and finally to the couple who brought in their adorable twin babies. It’s a really wonderful thing to see both Dr. G and the couple so happy when the treatments bear fruit.

Overall, the day at the clinic was very busy, with constant patient interactions, ultrasounds, phone calls, filing data, and all kinds of procedures. But it was really helpful to get exposure to this kind of work environment and see all the different aspects of a typical day in the clinic.

DAY 2

Buyan and Dr. Gordon

We started the day early this morning at INOVA Fairfax Hospital, where Dr. G gave a lecture on primary amenorrhea to the hospital’s residents and students at GW and VCU. He talked about the questions that a doctor would ask a patient if she had delayed puberty and about the different paths that would be taken in giving her treatment. It was great to see the academic side of things after getting to know the clinical setting yesterday. Dr. G’s lecture was really interactive and he asked a lot of questions to engage his students.

After the lecture, we went to the clinic in Arlington. Dr. G had three patients whose eggs were ready for collection, so while he was with his patients, I got to go into the lab again to watch Mark, one of the embryologists, go through the process of storing the collected eggs. He let me look into the microscope and explained to me how a darker cumulus around an egg could be an indication of egg immaturity, how to sterilize a pipette, how it’s used to transfer the egg into a medium for storage, how a desiccator is used to create the optimum environment for the eggs, and finally how they’re stored. The whole process was really complex and involved so much detail!

Around noon, we drove out to go to INOVA Fair Oaks Hospital, where Dominion Fertility had an office. Dr. G performed ultrasounds for a patient and did some consulting for another patient and her husband about treatments for ovarian cysts. On the drive back, Dr. G and I talked about the difficulty of identifying causes of cysts, especially given all the different types. We had some stimulating discussions about the ethical considerations and medical difficulties in providing cancer and HIV patients with fertility treatments.

Back at the clinic in Arlington, Dr. G had a meeting so I went into the lab to see the eggs that were collected earlier go through the intracytoplasmic sperm injection (ICSI) process. I found it really fascinating that there was so much dexterity involved in it. Mark and Jerry operated the pipettes with a lot of accuracy and care under the microscope, and I watched each moment a sperm was injected into an egg. It’s amazing to think that such a delicate process which provided an alternative solution to so many infertile couples was discovered by accident by a Belgian scientist, as Dr. G had told me earlier.

DAY 3

We started the day off at the Fair Oaks office with some ultrasounds and consulting for patients, and again it was really nice to see a couple who successfully had a baby from a previous treatment come back because they were ready for a second child. Back in Arlington, I got to see some more egg collections and the whole process of storing them in the lab. Then Dr. G went through the usual schedule of consulting, discussing the different treatment methods – from least to most proactive – with each couple.

I learned so much over the course of my three days with Dr. G. I would definitely recommend this Princeternship to other students. It’s a really good place to explore your interests if you’re looking at medicine as a career. Reproductive endocrinology is a very special field too, and the clinic is a unique, sought-after place where so many different patients go because of the availability of natural cycle IVF which is rarely offered elsewhere. Because of that, you’ll get to meet all kinds of patients and see how the doctors and nurses interact with them. Also, Dr. G is outgoing, helpful, and understanding, and on the way to different places, we had really interesting conversations about his experiences at Princeton, career choices, the daily life of doctors, ethical or political issues that they face, and any questions that I might have. I definitely had an inspiring Spring Break, and I’m really grateful to Dr. G and all the staff at Dominion Fertility for this wonderful opportunity.

I was very excited to begin shadowing Dr. Julia Korenman ‘78, a gastroenterologist at Digestive Disease Consultants in Rockville, Maryland. I arrived at her office at 7:45 in the morning. Before we did anything, I had to sign a privacy form as is standard in all hospital settings. Then she introduced me to some of the partners and nurses and showed me around the clinic. Since I was a little early, we had some time to talk about why I was interested in gastroenterology and what my future plans were in college. Next, she told me that she would be meeting with patients all day and showed me “our” schedule for the day. I was quite amazed by how many patients she saw each day. The patients were usually scheduled for 15- or 30-minute time slots and Dr. Korenman’s schedule only had an hour break for lunch, assuming everything goes perfectly according to schedule. Before I saw each patient, Dr. Korenman asked the patients if they were comfortable with a Pre-Med student observing their session. In case they were uncomfortable with having me in the room, Dr. Korenman gave me some reading material on common gastrointestinal diseases: celiac disease, hepatitis B and C, Irritable Bowel Syndrome (IBS), ulcerative colitis, Crohn’s disease, reflux disease, etc. The main reason I am interested in gastroenterology is that I had previously done research on IBS and really wanted to interact with patients and hear first-hand what it was like to have IBS. Sure enough, throughout the day, there were several patients with IBS and other inflammatory bowel diseases. Many of the patients were there for either endoscopy or colonoscopy consultations or follow-ups; nonetheless, I was very lucky to observe a wide range of GI diseases that day. I saw how Dr. Korenman tried to diagnose certain patients, performed abdominal examinations, explained the preparation and risks of endoscopies and colonoscopies, and checked if treatments were working. During the consultations, Dr. Korenman would often turn to me and clarify certain terminology and explain to me what was happening; after each meeting, we would go back to her office and I would ask her questions about certain things that I did not understand like proton blockers, concierge medicine, etc. Meanwhile, she also had to do dictations for each patient to send to the patients’ primary physicians. I was really amazed by the fast pace of the job. Even at lunch, Dr. Korenman was working on catching up on dictations, but we did have some time to just talk about Princeton, her medical career, the business aspect of private practice, etc. After lunch, we continued to see patients and I was able to see some other aspects of what it means to be a doctor. I learned about how doctors have to handle delicate and emotional situations and deal with complex new treatments with significant side effects. By around 4:30 pm, we had seen all of Dr. Korenman’s patients for the day. I really enjoyed being exposed to so many different aspects of what it means to practice medicine; it was certainly a lot to take in. I was really excited to watch the procedures (colonoscopies and endoscopies) the next day.

Tuesday, January 10th, 2012

Dr. Korenman and Zinan

Today, I arrived at the Gastrointestinal Endoscopy Associates Office, where Dr. Korenman performs procedures. When I got there at 8 am, I was required to sign another privacy form. Shortly afterwards, we went to the procedure room, where Dr. Korenman introduced me to the anesthetist and technician. The first two procedures I saw were endoscopies and I was able to compare and contrast the differences between healthy and inflamed upper GI tract. During the procedure, the patients are sedated; the anesthetist told me about the anesthesia she was using. I was able to not only see the vocal cords, esophagus, stomach and duodenum, but also see how sleep apnea can complicate an endoscopy. During the procedures, Dr. Korenman explained to me what she was doing and what we were seeing on the screen; we also had time for me to ask questions and the significance of nodes or to just talk about medical school, Princeton courses and how Princeton has changed over the past few decades. After each procedure, Dr. Korenman would fill out some forms on the computer and then we would inform the patients of their results, make sure they were feeling okay, and see if they have any additional questions. After the endoscopies, I was able to see several colonoscopies and a “double” (an endoscopy and colonoscopy). During the colonoscopies, we were able to see how effectively the preps worked at emptying the lower GI tract. Then, Dr. Korenman explained the significance of diverticulitis and hemorrhoids. I was also able to see the method for biopsies and removing colonic polyps. Before I knew it, we were done for the day.

During these two days, I was able to witness both consultations with patients and procedures. I found both days to be engaging in their own way; they offered two very different perspectives on practicing medicine. I found this Princeternship to be a very worthwhile experience. I accomplished my goal of learning more about gastroenterology and seeing first-hand how practicing medicine is very different from classes. After these two days, I am certainly more motivated to pursue a career in medicine and would strongly recommend this opportunity to students, who have not seen what it means to practice medicine. I would like to thank Dr. Korenman for taking time out of her busy schedule to accommodate me and for showing me what a career in medicine has to offer. In addition, I would like to thank Career Services for making this program possible.

Today, I shadowed Dr. Parham Ganchi ’87 at his clinic in Wayne, NJ. I was welcomed in by a member of his staff, who then gave me a tour of the clinic. It was an impressive display, from all of Dr. Ganchi’s diplomas to the spacious patient examination rooms to the private surgical operating room. Soon after, Dr. Ganchi himself arrived and we prepared for the long day that was to come. His schedule was packed, with patients coming in 15 minute intervals. There were a variety of procedures that patients were considering having, from cosmetic surgery to botox to laser/wrinkle hair removals. We also met with patients who were about to have their surgery, what he called a “pre-op”, to make sure that they were certain that they wanted to have the procedure. During the mini-breaks between patients, we talked about surgery and medicine in general, Princeton life, and our hobbies and lives outside of academics. Dr. Ganchi not only enlightened me in the realm of medicine but also on many topics that I wasn’t as well versed in, such as nutrition and the psychology of economics.

During the consultations, I really saw how engaging and compassionate Dr. Ganchi was as a doctor, making sure that all of his patients were fully informed on all the procedures and that they were comfortable in this environment. Many of the patients that were following up with him after their procedures were all extremely satisfied with their surgeries, which serves to demonstrate the great skill and dedication Dr. Ganchi brings to his field of medicine. It was really inspiring to see it all firsthand, and he will be the perfect role model for me to look up to as I pursue my own path towards medicine.

January 31, 2012

Stanley and Dr.Ganchi

Today was surgery day! I arrived bright and early to prep for surgery, getting scrubbed in and being informed on OR shadowing etiquette. I also met the anesthesiologist, Dr. Lee.
Both of the major surgeries done today were breast augmentation procedures, one with silicone implants and the other saline. He demonstrated the different techniques that went in with different implants, and showed his versatility and experience while performing surgeries on these patients. Throughout the surgery, Dr. Ganchi explained every step of the procedure and was very informative. Something that struck me was that he always had the patient’s best interest in mind. During the surgery, he was telling me that he had made a small incision under the breast of the patient, as opposed to a longer one, to prevent a larger scar from appearing. Even though that would make the surgery more complicated for him, he was more than willing to give the extra effort to make his patients satisfied with his work.

After the surgeries, I witnessed an earlobe repair surgery. The meticulousness and detail of his work showed through this procedure, as he slowly weaved back and forth with his stitches through the parts of the ear. I was surprised at how little time it took yet how natural the ear looked after the surgery, a testament to his skill and prowess.

I had come into this Princeternship on the fence about medicine and came out more positive than ever that medicine is the right track for me. I cannot thank Dr. Ganchi enough for all of the great wisdom and firsthand experience that I was able to obtain during these two days. I now have a great mentor and role model to follow and hopefully I will be able to open my own medical clinic some day. This Princeternship program was an amazing experience; the shadowing was more in depth than anything I had ever done and scrubbing into surgery for the first time was breathtaking. Everybody was really inviting and compassionate and really made me feel at home at the clinic. I would recommend this program to anybody that is unsure about medicine, because this will definitely help you make up your mind!

Dr. Gordon’s days usually start rather early, at 7:30am. Many of his patients stop by before they head to work so mornings are quite busy at Dominion Fertility. I saw Dr. Gordon do a lot of patient monitoring with ultrasounds. Most times the ultrasound was used to check on the quality and number of eggs available. They were also used to check that everything looked normal before treatment could be started, and several times I was able to see babies on the monitor. When the baby has reached a certain number of weeks and a heartbeat can be detected, the patient is sent back to her normal OBGYN with hopes for a healthy, successful pregnancy. At lunchtime we went to INOVA Fairfax Hospital, where Dr. Gordon spoke to resident OBGYN applicants about the great facilities available there. In the afternoon Dr. Gordon did more monitoring, along with patient consultations to discuss their future treatment. I was also able to see a hysterosalpingogram – an x-ray exam that uses fluorescent dye to image the uterus and fallopian tubes in order to detect scarring – at a hospital.

Day 2

In the morning I went with Dr. Gordon to INOVA Fairfax, where he gave a talk to residents on reproductive endocrinology and infertility. Then we went to the hospital’s business meeting, where administrators talked about statistics on patient satisfaction and plans for improving the hospital. I sat in on some more patient consults. We went to an OBGYN office in Reston where Dr. Gordon sometimes sees a small number of patients for consults, but does not actually perform any treatment. I was also able to see a natural cycle IVF egg collection. The embryologist showed me the egg once he had found it in the fractions. In the afternoon a very grateful patient of Dr. Gordon’s came in with cookies to celebrate her daughter’s first birthday.

Day 3

Dr. Gordon again did patient monitoring and consults to discuss a plan of action. We spent some time in the new office in Fairfax, which just opened at the end of last year. At the main office I was able to see an IUI and two more egg retrievals. Both patients were doing natural cycle IVF, and unfortunately the egg could not be found for one woman.

One of the most attractive things about working in reproductive endocrinology is that you really get to know your patients. Since women come in often for monitoring you are always aware of what is going on with them. With just three days at Dominion Fertility I started to recognize some of the women and knew when a certain test proved encouraging or discouraging. This Princeternship was so much more than I expected. I learned about life as a resident (mostly as an OBGYN resident), hospital administration, and infertility treatment. I saw elated women that were so happy to be pregnant, and I saw disappointed women whose treatment did not work out. I am so thankful that I had the opportunity to spend this time with Dr. Gordon.

On our first day at CHOP, we spent the day in clinic shadowing Dr. Howard Snyder ’65, a Senior Urologist in the Department of Urology. Everyone was really welcoming, and took time to accommodate our arrival. Dr. Snyder’s assistant, Ms. Brown, showed us around the urology department, and introduced us to all of the staff. Dr. Snyder had a full day lined up, and we were able to learn about the symptoms of common infections. Many of the cases were urinary tract infections. It was interesting to see how much Dr. Snyder relied on ultrasounds and other types of imaging in order to make a diagnosis. The nurse practitioner, Ms. Rudick, also took time to explain to us how to read the ultrasounds, and what abnormalities to look for. Throughout the day, Dr. Snyder also explained to us his work in lobbying Congress, and his role on different medical associations. It was eye opening to learn just how important government policy is to the day-to-day task of delivering medical care.

Day 2

Today we spent the day in the operating rooms. This was very exciting for me, since I had never observed any surgeries before. Though Dr. Snyder himself doesn’t operate anymore, we shadowed his colleague Dr. Lambert and the residents. The surgeries lined up for the day included testicular realignment, and hernia repairs. We were told that these surgeries were very typical. Dr. Lambert and the residents were very welcoming in answering questions, and made sure we understood what was going on. She was also very accommodating in making sure we could see what was going on. The entire operating room was equipped with video screens, and she also let us stand up on stools so we could view the surgery directly. Throughout the day, I also had a chance to talk with the residents about medical school, and why they decided to choose urology.

Day 3

Dr. Snyder, and the Princeterns

On our last day at CHOP, we spent half the day in clinic and half the day in the operating room. The cases in clinic this morning were more varied; there were cases of blood in the urine, a bike accident, and kidney stones. In the operating room, the cases were fairly similar to the ones we saw the previous day. We shadowed a different doctor today, and it was interesting to see the different approaches different surgeons had to the same cases. Once again, we had the opportunity to talk to the residents, and learn not only about the case going on, but also about life as a doctor. Overall, this was an amazing experience. Dr. Snyder is a great teacher, and has an extensive knowledge in all aspects of medicine. I would highly recommend this opportunity to anyone else interested in medicine!

On the first day of our Princeternship, the other Princerterns and Itook three trains, walked about fifteen minutes, and arrived at nine o’clock at the Children’s Hospital of Philadelphia. Sharon Brown, one of the administrators who works with Dr. Snyder, greeted us and gave us a tour of the Urology Department. She showed us around the clinic, including the exam rooms, scheduling desks, and physician offices, introduced us to the residents, who would, later in the day, take me to the OR. After the tour, the other two Princeterns spent the day shadowing Dr. Snyder in the clinic, while I spent the day in the operating room. Due to the small size of the exam rooms, all three of us could not shadow Dr. Snyder at once, so we took turns alternating between the clinic and the OR. I spent the first day observing three surgeries by Dr. Pat Casale. Before today, I had never observed a surgery or been in an OR, so this was something I was looking forward to experiencing. I felt quite professional in my blue scrubs and mask! Dr. Casale is the Director of Minimally Invasive Surgery for the Urology Department: he specializes in laparoscopic and robot-assisted surgeries. Today I was fortunate to see him, as well as the residents and fellow, Dr. Tasian, perform two laparoscopic surgeries as well as one surgery that required a larger incision due to the particularly complicated nature of the case. Everyone in the OR was very welcoming, and Dr. Tasian was kind enough to explain to me the basics of each surgery before it began. It was interesting to see how an OR is run with the urologists and anesthesiologists working together. Care is put into every surgery. For example, before an incision is ever made, the attending physician has to do a “time out” recognizing the OR team members present, reviewing the procedure that is to be done, and any relevant patient history. After the surgeries for the day had ended, we returned to Dr. Snyder’s office and discussed various aspects of medicine, including his personal life story, public policy, and the Mutter Museum of Medical Sciences in Philadelphia. He explained to us how there is a need for more young urologists. Right now, the number of urologists is in decline and the average age of urologists is getting older. This first day was an incredible way to start my Princeternship! My biggest accomplishment: not fainting or feeling sick during the OR procedures- Yeah!!

Day 2

Dr. Snyder, and his Princeterns

I spent today shadowing Dr. Snyder in clinic. Dr. Snyder works closely with Nurse Practitioner Kristen Rudnick, so I was able to observe them working together as a team. Dr. Snyder was often able to console anxious patients, telling them that surgery was unnecessary after reviewing the patients’ charts and medical tests. Dr. Snyder explained that radiologists tend to report pathology instead of explaining what is actually seen on the ultrasound, causing patients to end up in Urology for a normal variant, rather than a pathological kidney. I watched Dr. Snyder read multiple renal ultrasounds that day. Dr. Snyder interacted amiably with both the patients and the parents, taking the time to make sure that the patient’s parents understood the diagnosis. He then dictated a letter on each patient, while the patient was offered a sugarless lollipop! In the evening we attended a radiology rounds meeting with the residents and attending physicians. During this meeting, various residents presented the radiology images from particularly complicated cases so that all of the physicians could discuss the case and help the treating physicians ensure that they are following the most appropriate course of treatment. I noticed during the meeting the amount of respect that the other physicians had for Dr. Snyder, the most senior attending physician. They often said, “What do you think, Howard?” What I learned today: being a physician is not like what is seen on the TV show House. Respect and teamwork are essential!

Day 3

On the final day, I spent the morning in the OR and the afternoon in the clinic. In the morning, I observed Dr. Kolon, another of Dr. Snyder’s partners, in the OR. I observed two of his procedures. We spent some time talking about the best way to prepare academically for medical school. In the afternoon, I shadowed Dr. Snyder again, learning more about methods for effective patient care. Dr. Snyder gave me articles to read concerning common urological conditions that we had been seeing in patients that day. Final thought: this Princeternship crystallized my desire to become a physician. I recommend this Princeternship to anyone interested in an up close and personal medical experience with multiple doctors and perspectives in a premier medical setting!

Walking into the Child and Adolescent Psychiatry building on a brilliant, Californian winter day seemed to reflect my feelings for the day: bright and optimistic. I had definitely been enjoying my winter break, but I couldn’t wait to begin myPrinceternship with Dr. Kiki Chang ’88, the Director of the Pediatric Bipolar Disorders Program who is also an Associate Professor at Stanford University School of Medicine, a child psychiatrist, and administers clinical research.

Evaline, the other Princetern, and myself had contacted Dr. Chang in the weeks leading up to the Princeternship, which helped us choose the best times and dates for all of us. We arrived in the lobby of the psychiatry building in the morning and waited for Dr. Chang to meet us there – unfortunately, his son had to be picked up sick from school. Instead, one of his clinical research coordinators, Rosie, happily met us in the lobby and brought us upstairs to her office and the “headquarters” of some of Dr. Chang’s research. While Rosie prepared for the upcoming “case-ad”, an interview with one of the subjects from a study, she enthusiastically answered our questions and provided us with a great background on what we would be sitting in on for the morning. We would be observing the longitudinal part of one of Dr. Chang’s studies, “Identification of Genetic and Neurobiological Risk Factors for the Development of Early-Onset Bipolar Disorder” with a healthy control subject. Although the study focuses on discovering the possible factors of neurochemistry, genetic markers, and brain activations patterns that contribute to the onset of bipolar disorder, we learned that it is important to have healthy control subjects (those who do not have ADHD or mood problems or a parent with bipolar disorder) in order to compare results and claim significance.

Rosie took us to Meghan Howe’s office, who is one of the Clinical Research Managers, where Dr. Chang quickly welcomed us and introduced himself to us before Meghan began the “case-ad” with the healthy control subject. The case-ad, in which Meghan interviewed the healthy subject about possible symptoms for mood disorder, lasted about a half hour. Afterwards, we accompanied Rosie and the healthy control subject while Rosie administered a few follow-up tests. Rosie administered the Affect Recognition, or the NEPSY test, which is used to evaluate a child’s neuropsychological development through testing basic and complex aspects of cognition. We also observed the healthy control subject take the “MultiMorph” test, which uses a computer to morph a picture of a face from one mood to another (i.e., an angry face to a happy face).

When the healthy control subject left, we met Dr. Chang in the lobby where he brought us outside to the “Nom Nom Truck” (http://nomnomtruck.com/) for a delicious Vietnamese meal to-go. While waiting for our food, Dr. Chang was enthusiastic about getting familiar with our interests, our passions, and our goals, and we found that many of our interests overlapped. Dr. Chang and I found out that we even share the same residential building, Joline! We brought our lunch to a communal meeting with many prestigious psychiatrists, analysts, researchers, and mentors who discussed current research, ways to better research, and ways to better collaborate. The meeting brought together some of the brightest minds and experts in pediatric mood disorders. Straight from the meeting, Dr. Chang brought us to his office for another meeting with Rex Huang, the Chief Fellow of Child and Adolescent Psychiatry at Stanford Hospital and Clinics. Dr. Chang and Dr. Huang discussed recent patients, any dosage or medication changes, and any updates. It was really interesting to get a glimpse of Dr. Chang’s overarching role in the clinic and to hear snapshots of Dr. Huang’s individual and direct work with his patients.

Following that meeting, we rushed to a meeting with Alan Reiss, one of Dr. Chang’s mentors and head of the neuroimaging lab, for a consultation on the findings of one of Dr. Chang’s more recent studies. Amy Garrett, a Research Scientist and Neuroimaging Manager, Ryan Kelley and Spencer Boucher, neuroimaging research assistants, were also there to discuss the findings and the best possible way to present and publish them. From what I could understand, the study, CAFENE, used MRI to evaluate the neurological response to viewing images of a fear face, a calm face, or a neutral face. It was a great collaborative effort and the meeting worked as a conversation, with each person providing insight and asking further questions to better the understanding of the findings.

Afterwards, Amy Garrett and Victoria Cosgrove met us in Dr. Chang’s office before heading off to another meeting. Dr. Chang drove us to the “Lucille-Packard Foundation” donor presentation, which we all thought would be a small meeting. We were all surprised when we walked into a room full of business suits, but Dr. Chang nonchalantly and humbly began his presentation. He opened the presentation with the importance of funding for Bipolar Disorder, especially in accordance with its “de-stigmatizing”. Listening to Dr. Chang speak, I realized that, despite his success, he must overcome much adversity in order to receive recognition or donations for his research. The social stigma of Bipolar Disorder discourages many people from donating, especially when there are people out there who still believe that Bipolar Disorder doesn’t exist or is simply an exaggeration of teenage “temper tantrums.” Dr. Chang went on to present a summary of his work, discussing comorbidity factors, the difficulty of applying adult findings to children and adolescents, and how it affects a child’s education. In the end, the meeting came together to brainstorm ideas on how to raise money for Dr. Chang’s incredible work.

When Dr. Chang dropped us back off at 401 Quarry Road, I walked away with an immense amount of knowledge. Not only did all of my background research come together and apply to each of my experiences from today, I had learned so much about Dr. Chang’s career and the careers of his colleagues. Everyone I had met was very enthusiastic and welcoming, but more importantly, they were all very down-to-earth. Dr. Chang was incredibly personable, friendly, and humble. It was definitely refreshing to see Dr. Chang, a man so modest with his success, in this business environment because his likability was impossible to deny. Looking back, I realized Dr. Chang’s personality is evident in all of his relations with his colleagues we observed today, making for a very successful, upbeat atmosphere. Today I learned a lot about pediatric bipolar disorder, its research, and psychiatry, but I also learned the importance of personality in the workplace. I can’t wait to start another day with Dr. Chang tomorrow!

Day Two

Taylor, fellow Princetern Evaline, and Dr. Chang

Evaline and I met Dr. Chang in the lobby and quickly went to his office where we had a “debriefing session”. Dr. Chang first discussed mindfulness, the art of being aware of ourselves, and controlling our emotions and how this is involved in his future work. He then discussed the grant writing process that accompanies any research. He filled us in on the differences between mutltiple grant proposals he is writing. We were pretty intrigued by the approval process and review panel, which seems to exist very subjectively. From what I understand, a grant can be approved or turned down based on the opinion of one person, which makes for a pretty competitive system. Furthermore, Dr. Chang shared with us the pathway that brought him to his profession. I found his experiences relatable and enlightening, opening up my eyes to options I hadn’t considered yet. He is a strong advocate for engaging in whatever makes one happy, “you won’t be successful unless you enjoy what you are doing,” he told us. I found these to be powerful words, especially from such a successful man who really contemplated the steps he took to get him to where he is now. His job embodies what he loves to do: he has a balance of research, of clinic involvement, or academia, of teaching, of pediatrics, and of travel. Dr. Chang was interested in our lives, as well, and we shared our experiences and hopes with him in return. We all seemed to harbor the “social conscious” that brought Dr. Chang to medicine.

After our debriefing session, Evaline and I went to lunch at the nearby Stanford Shopping Center and ordered sandwiches from La Baguette – a great, cute café. Over lunch, we were able to reflect on our experience so far and share our excitement for the upcoming plans Dr. Chang had for us. We met up with Dr. Chang at the clinical mood disorder meeting with other psychiatrists, psychologists, and therapists who work in the clinic. The group discussed intakes, patients’ updates, and Dr. Chang ended the meeting by teaching the group about clinical trials. He went over interventions and whether it be medication, therapy, education, CBT, DBT, or mindfulness. He then taught about the efficacy of trials, whether a subject is in remission or recovery, and the different measures of deciding these labels. The importance of NNT (number needed to treat) and NNH (number needed to harm) in clinical trials and medications was then discussed, teaching us that a medication with a low NNT and a high NNH is the most productive.

Afterwards, we had the opportunity to shadow Dr. Chang in the clinic. We sat in on four appointments, each with a girl in her teenage years. The patients had mood disorders from depression to bipolar disorder, from anxiety to schizophrenia. Often, Dr. Chang would first converse individually with a patient before bringing her parents in. The meeting served primarily to discuss dosage, but in order to discern which dosage would be appropriate, Dr. Chang needed behavioral updates from the individual and her family, as well as any updates on side effects. Dr. Chang filled us in on the background history of each patient, who all seemed to be doing well with treatment and experiencing improvements. Seeing Dr. Chang work in the clinic allowed me to understand what it would be like to be a practicing psychiatrist, the types of illness and issues a psychiatrist might deal with, and the ways in which a psychiatrist can directly and indirectly help a patient. Once again, I walked away with an incredible amount of new information and an invaluable experience that will certainly leave an impression on which medical pathway I’d like to take.

Day Three

Today, Evaline and I had the great opportunity to meet with Amy, Spencer and Ryan again in Alan Reiss’s neuroimaging lab. We first met with Amy, who evaluates the neurology of eating disorders, mood disorders, and memory in elderly, to discuss the neuroimaging fMRI. She explained to us the physics and statistics of fMRI and explained to us the functional contrasts that we see in a brain scan. Furthermore, we learned about the traditional vs. original design of task-oriented scans, lowering the percent of unusable scans, and the variability that must be considered when evaluation a scan. For instance, you must understand and consider the comorbidity factors, the medication, and environmental factors when evaluating a scan. She also went on to lament the difficulties in recruitment for research and acknowledged that the likability Dr. Chang exhibited is extremely helpful not only for funding and for grants, but for recruitment as well. We then spent time with Spencer, who intelligently explained to us the program “FreeSurfer”, which traces parts of the brain and discerns between white matter and grey matter. He spoke more about structural imaging, normalization, and the corrections that must be done with scans. Spencer showed us some of the faces used during the CAFENE study we heard about during a meeting on Monday, which were amusing and gave us all a good laugh. In addition, he talked about the simulation subjects must undergo before getting a real fMRI scan. They usually place a subject in a simulated fMRI scan with a video of Spongebob or a popular television show playing. If the subject moves, the video stops for four seconds in hopes of training the subject to stay still. With Spencer, we also talked about his major, cognitive science, and how he ended up where he is. I found this to be really helpful because it gave me a great sense of what someone can do with a degree or major and how I can use my abilities in the neuroimaging field.

Our final stop in the neuroimaging lab was with Ryan, one of the lab’s favorite employees. Ryan was working on finalizing the CAFENE study paper we discussed in the meeting on Monday and helpfully went over the paper with us – by the end of our meeting with Ryan, we really understood all the scientific and complicated terms from the original CAFENE meeting. Ryan told us that CAFENE stood for CAlmFEarfulNEutral and explained that the calm face was used as the baseline because bipolar kids had a neurological response to the neutral face. We first went over the primary analysis, the establishment of whether or not bipolar kids have more activation in certain parts of their brain, in this case, the amygdala. We then went over the post hoc analysis, evaluating the genetic implications of the study. This dealt with the SERT allele, which was taken from a blood sample or a saliva test. We learned about the importance and power of integrating brain, behavior, and genes in a study for the integration provides the best answers to the questions. Ryan also told us about the difficulty of the research and the change from undergraduate writing to scientific writing, which tends to be short and simple, full of limitations. The morning in the neuroimaging lab taught me a lot about a field that I am finding very interesting and would like to explore more. The experience also showed the collaboration between medicine and technology, something I am also very interested in.

Evaline and I had lunch at the café downstairs and went to the cubicles upstairs for a little downtime and some work. We had been so busy the past two days that it was nice to relax for a while and reflect on what we had learned so far. Everyone we ran into while we were upstairs was so welcoming, engaging, and nice – it was a great environment to be in. After our break, we met back up with Dr. Chang and his colleagues, many of whom we already worked with, for a lab meeting. Recruitment, updates, announcements, and bonding options were all discussed during the meeting. Once again, it was great to see how many people are involved with Dr. Chang’s work and each of their individual and group roles.

Afterwards, we were able to see one of the patient’s from Dr. Chang’s clinical trials, which he had taught his colleagues about in the meeting from yesterday. He had to interview the patient on her comprehensive history symptoms of bipolar disorder and discuss medication with her parents. The interview was upbeat and Dr. Chang created a great atmosphere for the patient, making her feel comfortable during the process.

Unfortunately, the end of the interview signaled our last moments of the Princeternship. I am definitely sad to leave Stanford and the experience with Dr. Chang, but I am so glad I got the opportunity to learn so much. I would definitely recommend this Princeternship to students interested in psychology, neuroscience, or medicine. My time at Stanford affirmed my interest in helping those around me and exploring medical school. I’m extremely grateful to Dr. Chang for the opportunity to learn more about his area of expertise, his career, and his path to success. It was an invaluable experience for which I will always be appreciative.

This morning I rode the train to Philadelphia with two other students to meet Dr. Howard Snyder ‘65 at the Children’s Hospital of Philadelphia. Dr. Snyder is a renowned urologist who helped establish the division at CHOP. When we arrived, Dr. Snyder and his assistant, Sharon Brown, were very welcoming and showed us around the Division of Urology. Evelyn Siu ’15 and I decided to shadow Dr. Snyder today in clinic. By 9:30 am, we were quickly absorbed into Dr. Snyder’s routine. His first patient was a baby girl who had recently been taken to the emergency room for a very high fever. She was suspected to have had a urinary tract infection (UTI). Dr. Snyder explained UTIs very carefully to the girl’s mother and I was impressed by Dr. Snyder’s focus on education. With all his patients, he made sure to explain to the parents what was occurring. It was clear that the parents found Dr. Snyder’s explanations very helpful, and reassuring in some cases. Other patients that came to Dr. Snyder today ranged in the ages from eight months to thirteen years old. Some of them had recent UTIs while others came in for kidney and reflux concerns. I learned the differences between the symptoms of a bladder infection versus a kidney infection and how to look at renal scans. I am really impressed by how much I learned today. Shadowing Dr. Snyder was very exciting and I cannot wait to come back tomorrow.

Wednesday, January 11, 2012

Dr. Snyder and his Princeterns

Instead of shadowing Dr. Snyder today in clinic, we were given the opportunity to shadow one of Dr. Snyder’s colleagues, Dr. Sarah Lambert, in the operating room (OR). We were introduced to the urology residents and were then shown to the locker rooms where we dressed in scrubs. In the OR, I saw the anesthesiologist team prepare the patient for surgery. Once the patient was anesthetized and doing well, Dr. Lambert and the resident surgeons were allowed to proceed with the operation. The three surgeries today included a hernia repair and an orchiopexy (an orchiopexy is an operation to move an undescended testicle into the scrotum). The duration of each operation ranged from 90 minutes to two hours and we were allowed to stand near the operating table to get a closer view of the operation. Throughout each operation, the residents and Dr. Lambert explained to me the process of the operation and what they were doing. I understood the general idea of each operation, but as for the specific steps, I was a little lost trying to distinguish the vas deferens, for example! The hernia repair was very interesting to watch as well because it proved to be a challenge and more difficult than expected. I was impressed to see the teamwork involved. The surgeons and nurses discussed the operation and what ought to be done, almost like working through a puzzle.

After Dr. Lambert finished operating for the day, Dr. Snyder took us to a meeting for the entire urology division. The residents presented difficult or challenging cases and asked for input. The cases provoked much discussion among all the surgeons as they presented various suggestions and ideas. I really enjoyed the opportunity to see on a first-hand basis the collaboration necessary in medicine. It was a long and tiring day, but I rode the train back to campus feeling very enthusiastic and satisfied with my day.

Thursday, January 12, 2012

In the morning, I first shadowed Dr. Snyder in clinic. Many of the cases were very similar to Tuesday. Dr. Snyder once again exhibited his expertise and dedication to teaching the parents of his patients. After seeing a few patients, I shadowed another surgeon in the OR. This time I saw two operations, a cystoscopy and another orchiopexy. The procedure for the orchiopexy was almost the same as what I had seen yesterday. The cystoscopy on the other hand was very different. The original intent of the procedure was to apply deflux inside the bladder at the opening of the ureters to prevent reflux. The surgeon inserted a camera through the urethra of the patient and into the bladder. The image was displayed on multiple screens throughout the room and I was able to clearly see the tissue lining the urethra and the bladder. The residents looked for the openings to the ureters, which proved to be very difficult due to the anatomy of the patient’s bladder. As a result, they were unable to proceed with the procedure and had to finish the cystoscopy as they discussed further possible treatments. After the cystoscopy, we talked for some time with the residents about pursuing a career in medicine and surgery. I found that talking to the residents was very valuable because they recently had finished medical school and were familiar with the process in general. Soon it was time to say good-bye to everyone at the urology division of CHOP. We all felt a little sad about leaving, as we had just gotten to know everyone and we were having a fantastic time. I thoroughly enjoyed my experience at CHOP and I am so thankful to Dr. Snyder and everyone in Urology for giving me the opportunity to really see what a career in surgery entails.

Comparisons of medicine to veterinary medicine are often made cautiously. Nonetheless, I compared pediatrics to veterinary medicine and thus, ruled it out as a medical specialty. As an animal lover, I avoided veterinary medicine and the prospect of euthanizing someone’s beloved pet. And since I love kids, I never really considered pediatrics until this Princeternship! I spent part of reading period shadowing Dr. Debra Palazzi (attending) and Dr. Chase McNeil (fellow) who are part of the pediatric infectious disease team at Baylor College of Medicine.

The first day began early. The other Princetern Tola, and I, were out of the house before 8:00 am in order to beat Houston’s morning traffic and arrive at Texas Children’s Hospital early (we’re all about a good first impression!). Dr. Palazzi met us in the lobby and then we went to her office in order to discuss her plans for the week. In addition, Dr. Palazzi gave us the opportunity to ask her questions about her work in pediatric infectious diseases, her life at Princeton, our shared dislike of organic chemistry, and medical rotations in medical school.

Then, the fun really began: rounds! We had the opportunity to see really interesting yet sad cases:

(Yet, not all the cases we saw were sad. We also had a new consult who was not sick.)

We got a chance to attend an Osteomyelitis Conference where radiologists, orthepedic surgeons, and members of the infectious disease team discussed three of the patients. The conference was extremely interesting because I got a chance to see how different medical specialists process the same information.

On the second day, we revisited a majority of the first-day patients during rounds. Our visits this day were focused on updating or confirming the drug regimen depending upon the results of previously ordered cultures and blood tests. The second day also differed from the first because we changed locations! We conducted our outpatient visitation in the Children’s Critical Center. The patient we visited had chronic osteomyelitis but appeared to be recovering well—this was certainly good news after a slew of melancholy cases before.

Afterwards, we made our way down to the labs for micro-rounds. During micro-rounds, we were able to see our patients’ fungal and bacterial cultures and discuss ways of treating the infections. During our discussion I was really glad to be taking EEB 211 (Chaos and Clockwork of Biological Design) this semester.

Tola and I attended a conference called Fashioning Parasitic Antigensinto Recombinant Protein Vaccines. The conference was focused upon global health (an interest of mine) and discovery and allocation of affordable vaccines for tropical diseases which are generally found in less developed nations. We also got a chance to sit in on a meeting to discuss the plan of action for a ten-year old boy who had quite progressive osteomyelitis. The meeting including his oncology team, the infectious disease team, and orthopedic surgeons. The discussion was obviously serious as the options for the boy were (1) immediate amputation or (2) an attempt to get rid of the infectious and subsequent amputation, only if necessary.

On the third day, we continued with rounds and I think the most striking case of the day was a two month old who may (or may not) have inherited syphilis from his mother. After seeing tons of cases in which infection was unpreventable, it was odd to see a case where infection was entirely preventable. Luckily, penicillin will help.

Overall, I got to shadow two amazing doctors who had extremely interesting cases, but what else did I learn?

The world of medicine may not be as glamorous as it is portrayed in Grey’s Anatomy, but it is certainly just as exciting.

I am extremely, extremely interested in pediatrics.

I shouldn’t stress out about organic chemistry. It has little to nothing to do with actual medicine.

Medicine is an extremely collaborative field. So, the competitive pre-med lifestyle definitely does more harm than good.

I definitely enjoyed my Princeternship and I strongly recommend Princeton students apply for a Princeternship yourself. Who knows, you may discover your career path.